Osteochondral Fresh Allograft Transfer to Address Osteochondral Defect of the First Metatarsal Head in Early Hallux Limitus

Background: Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Methods: Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Results: Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ2 tests: P > .05). Conclusions: No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

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Functional Hallux Limitus

Journal of the American Podiatric Medical Association ◽

10.7547/0980236 ◽

2009 ◽

Vol 99 (3) ◽

pp. 236-243 ◽

Cited By ~ 8

Author(s):

Beverley Durrant ◽

Nachiappan Chockalingam

Keyword(s):

Sagittal Plane ◽

Proximal Phalanx ◽

Metatarsal Head ◽

The Body ◽

Evidence Based ◽

Joint Motion ◽

Detailed Review ◽

Hallux Limitus ◽

First Metatarsal ◽

Gait Characteristics

Functional hallux limitus is defined as a functional inability of the proximal phalanx of the hallux to extend on the first metatarsal head during gait. The theory concerning this anomaly and the altered gait characteristics that may result appears to have influenced the understanding of sagittal plane podiatric biomechanics. Although there is an increase in the body of evidence to support the proposed gait alterations, a detailed review suggests the need for further work. The aim of this article is to review the functional hallux limitus literature and its reported effects on gait. Furthermore, we explore some of the key and inherent problems with obtaining accurate data for joint motion measurement in the foot. With evidence-based practice now at the forefront of both clinical and academic practice, it is imperative to review the literature that underpins a particular commonly held or historical belief, in order to substantiate and validate subsequent diagnoses and treatments provided in light of this information. This is also true to advance the understanding of a particular anomaly or pathology and to inform so as to facilitate the provision of better care to patients. (J Am Podiatr Med Assoc 99(3): 236–243, 2009)

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Plantar Pressure and Joint Motion After the Youngswick Procedure for Hallux Limitus

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-94-1-22 ◽

2004 ◽

Vol 94 (1) ◽

pp. 22-30 ◽

Cited By ~ 11

Author(s):

Alan R. Bryant ◽

Paul Tinley ◽

Joan H. Cole

Keyword(s):

Pressure Distribution ◽

Peak Pressure ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Joint Motion ◽

First Metatarsophalangeal Joint ◽

Hallux Limitus ◽

First Metatarsal ◽

Second Metatarsal

The effects of the Youngswick osteotomy on plantar peak pressure distribution in the forefoot are presented for 17 patients (23 feet) with mild-to-moderate hallux limitus deformity and 23 control subjects (23 feet). During 2 years of follow-up, the operation produced a significant increase in the range of dorsiflexion of the first metatarsophalangeal joint in these patients, reaching near-normal values. Preoperative and postoperative measurements, using a pressure-distribution measurement system, show that peak pressure beneath the hallux and the first metatarsal head remained unchanged. However, peak pressure was significantly increased beneath the second metatarsal head and decreased beneath the fifth metatarsal head. These findings suggest that the foot functioned in a less inverted manner postoperatively. Compared with normal feet, hallux limitus feet demonstrated significantly higher peak pressure beneath the fourth metatarsal head preoperatively and postoperatively. (J Am Podiatr Med Assoc 94(1): 22-30, 2004)

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Length of the Sesamoids and Their Distance From the Metatarsophalangeal Joint Space in Feet With Incipient Hallux Limitus

Journal of the American Podiatric Medical Association ◽

10.7547/0980123 ◽

2008 ◽

Vol 98 (2) ◽

pp. 123-129 ◽

Cited By ~ 12

Author(s):

Pedro V. Munuera ◽

Gabriel Domínguez ◽

Guillermo Lafuente

Keyword(s):

Metatarsophalangeal Joint ◽

Inverse Correlation ◽

Metatarsal Head ◽

Joint Space ◽

Hallux Limitus ◽

First Metatarsal ◽

Significant Difference ◽

Distal Edge ◽

The Relationship ◽

Moderate Inverse Correlation

Background: We designed this study to verify whether the sesamoids of the first metatarsal head are longer than normal in feet with incipient hallux limitus, and whether feet with incipient hallux limitus are in a more proximal than normal sesamoid position. Methods: In a sample of 183 dorsoplantar radiographs under weightbearing conditions (115 of normal feet and 68 of feet with slightly stiff hallux), measurements were made of the length of both the medial and the lateral sesamoids and of the distance between these bones to the distal edge of the first metatarsal head. These variables were compared between the normal and the hallux limitus feet. The relationship between these variables and the hallux dorsiflexion was also studied. Results: We found significant differences between the two types of foot in the medial and lateral sesamoid lengths, but no significant difference in the distance between the sesamoids to the distal edge of the first metatarsal. A poor-to-moderate inverse correlation was found between hallux dorsiflexion and medial sesamoid length and between hallux dorsiflexion and lateral sesamoid length. Conclusions: The length of the sesamoid bones of the first metatarsal head could be implicated in the development of the hallux limitus deformity. (J Am Podiatr Med Assoc 98(2): 123–129, 2008)

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First Metatarsal Head Osteochondral Defect Treatment With Particulated Juvenile Cartilage Allograft Transplantation: A Case Series

Foot & Ankle International ◽

10.1177/1071100717737482 ◽

2017 ◽

Vol 39 (2) ◽

pp. 236-241 ◽

Cited By ~ 8

Author(s):

Bryan Van Dyke ◽

Gregory C. Berlet ◽

Justin L. Daigre ◽

Christopher F. Hyer ◽

Terrence M. Philbin

Keyword(s):

Articular Cartilage ◽

Osteochondral Defect ◽

Case Series ◽

Metatarsal Head ◽

Retrospective Case ◽

Level Of Evidence ◽

First Metatarsal ◽

Allograft Transplantation ◽

Case Series Study

Background: Focal damage to articular cartilage, also called an osteochondral defect (OCD), can be a cause of pain and decreased range of motion. Recent advancements have led to transplantation techniques using particulated juvenile articular cartilage allograft. This technique has been applied to the first metatarsal head to a very limited degree, with no published results to our knowledge. The aim of this study was to review the clinical results of patients who underwent particulated juvenile cartilage allograft implantation for first metatarsal head OCDs. Methods: We performed a retrospective consecutive case series study. Nine patients, at an average age of 41 years, were treated for symptomatic focal osteochondral defects of the first metatarsal head with particulate cartilage grafting from 2010 to 2016. Patients were contacted by phone to assess interest in returning to the office for follow-up, where weightbearing radiographs of the foot were obtained and a foot examination was performed. Results: At an average follow-up of 3.3 years, 7 of 9 patients reported no pain with recreational activities and no patient required further operations. This patient cohort was physically active, with 6 of 9 listing running as a regular activity. The average overall American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire score was 85 (maximum 100), AOFAS pain 35.6 (maximum 40), and AOFAS function 40.1 (maximum 45). Patient satisfaction surveys correlated with the AOFAS scores and revealed that 7 of 9 patients were very satisfied with their results, 1 was satisfied, and 1 patient was very dissatisfied. Conclusion: Particulated juvenile cartilage allograft transplantation is a promising treatment option for symptomatic first metatarsophalangeal focal articular cartilage lesions. Further study is needed to demonstrate which lesions respond better to this type of cartilage graft versus traditional marrow-stimulating procedures. Level of Evidence: Level IV, retrospective case series.

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Effects of Hallux Limitus on Plantar Foot Pressure and Foot Kinematics During Walking

Journal of the American Podiatric Medical Association ◽

10.7547/0960428 ◽

2006 ◽

Vol 96 (5) ◽

pp. 428-436 ◽

Cited By ~ 42

Author(s):

Bart Van Gheluwe ◽

Howard J. Dananberg ◽

Friso Hagman ◽

Kerstin Vanstaen

Keyword(s):

Three Dimensional ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Limited Attention ◽

Foot Pressure ◽

Foot Kinematics ◽

First Metatarsophalangeal Joint ◽

Hallux Limitus ◽

First Metatarsal ◽

Peak Plantar Pressure

The effects of hallux limitus on plantar foot pressure and foot kinematics have received limited attention in the literature. Therefore, a study was conducted to assess the effects of limited first metatarsophalangeal joint mobility on plantar foot pressure. It was equally important to identify detection criteria based on plantar pressures and metatarsophalangeal joint kinematics, enabling differentiation between subjects affected by hallux limitus and people with normal hallux function. To further our understanding of the relation between midtarsal collapse and hallux limitus, kinematic variables relating to midtarsal pronation were also included in the study. Two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics. The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head. Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads. Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur. (J Am Podiatr Med Assoc 96(5): 428–436, 2006)

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